Membership Form

Title:      Forename:    Surname:

Address:

Town:

County:   Post Code:

Country:

Telephone:

Email:

Name(s) of Associates(s):

 Members @ £20 (£25 outside UK):  Associates @ £5:   
Corporate Members @ £20 (£25 outside UK):        Total:

My/Our main interests are (tick all that apply):

Specific Interests:

www.halifaxhistory.org.uk
Registered Charity No. 1050252

If you are a UK tax payer please complete this gift aid declaration as this will enable us to collect an extra 28p for every pound paid

 GIFT AID DECLARATION

I want the Halifax Antiquarian Society to treat all payments I have made since 6 April 2000 and all donations I make from the date of this declaration until I notify you otherwise as Gift Aid Donations.

 Amount enclosed:£ 

Signature: ..............................................................

Date: ...........................................................

Notes

1. Please notify the charity if you change your name and address while the declaration is still in force.
    

2. You can cancel the declaration at any time by notifying the charity ‑ it will then not apply to donations made on or after the date of cancellation or such later date as you specify.
    

3. You must pay an amount of income tax and/or capital gains tax at least equal to the tax that the charity reclaims on your donations in the tax year.
    

4. If you pay tax at the higher rate you can claim further tax relief in your Self Assessment tax return.
    

5. If you are unsure whether your donations qualify for Gift Aid tax relief, ask the charity. Or you can ask your local tax office for leaflet IR 113 Gift Aid.

PRINT

Please print out and send it with your payment to:
Membership Secretary, Halifax Antiquarian Society, 37 Green Park Road, Halifax HX3 0SN, UK
Cheques (£ sterling only) should be made payable to "Halifax Antiquarian Society"